4 steps for provider buy-in on new payment models


When insurers collaborate with providers to break down silos and create new ways of working together, they can successfully implement new payment models that boost quality and value throughout the healthcare system.

"We are all collectively responsible" for enhancing value, Shaun Frost, associate medical director of care delivery system for HealthPartners Health Plan in Minnesota, said Friday during a breakout session at AHIP Institute 2014 in Seattle.

His co-presenter, Lili Brillstein, director of episodes of care for Horizon Healthcare Innovations in New Jersey, agreed. "It's the interaction between payers and providers that needs to change to get value and quality," she said.

To improve the interactions and enhance collaborations, insurers and providers must start thinking differently and stop blaming each other for problems. Frost and Brillstein laid out four steps all insurers can take to boost their collaborative efforts as they shift from volume- to value-based payments:

1. Start with early adopters

Frost advised against the wholesale introduction of a new payment model to all networked providers. Instead, insurers should launch new reimbursement methods with early adopters, which he described as doctors who are willing to try new things and see value in innovations. Additionally, Brillstein said insurers should start by incorporating up-side risk only. That way, providers aren't engaging in significant risk and will be more willing to participate in a value-based payment method.

2. Be flexible

There is no silver bullet that will please all providers within an insurer's network. But there are many strategies insurers can incorporate. Frost recommended insurers be willing to customize the options to give doctors several reimbursement choices and operate different payment models simultaneously.

3. Share data

Ideally, insurers should be sharing data in a dynamic way with providers participating in value-based payment programs, Frost said. Providers should be able to interface with the information on a real-time basis to create custom analyses. Moreover, insurers shouldn't just dump data on providers and expect them to analyze it. HealthPartners, for example, meets face-to-face with its providers to help them analyze and understand the information and draw conclusions, Frost said.

4. Treat providers as partners

When insurers treat providers as their partners, they can establish trust and integrity in the relationship. For example, don't treat innovative ideas as a commodity. They should share information openly with the goal of helping providers boost quality and value for their members. Similarly, Frost said insurers should allow doctors to provide input on the payment model through regular roundtable meetings so they can share their opinions and assessments.

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